CMS enforcement of new price transparency rules began on January 1st. ClaraPrice has summarized the new requirements below. If you have any questions, please schedule a free consult with ClaraPrice at claraprice.com.
Standardization of Files and Data for Consumer Access and Readability
CMS is standardizing the machine-readable file (MRF). Hospitals must now display their standard charge information in a CMS template layout, following data specifications and a data dictionary.
Improved Accessibility for Oversight
Hospitals must now place a ‘footer’ at the bottom of their homepage. This footer must link to the webpage, which includes the MRF. It must include a .txt file with the following:
- Hospital location name, which corresponds to the machine-readable file.
- The source page URL that hosts the machine-readable file.
- A direct link to the machine-readable file in the URL.
- Hospital point of contact information.
Affirmation Statement
Beginning July 1, 2024, the hospital must affirm that, to the best of its knowledge and belief, the hospital has included all applicable standard charge information and that the information encoded is true, accurate, and complete as of the date specified.
Estimated Allowed Amount
A new data element, the estimated allowed amount, must be included in the MRF by January 1, 2025. CMS requires the historical allowed amount, an average reimbursement in dollars received from the payer in the past for an item or service. This data element will reflect the estimated dollar value when a standard charge is based on an algorithm or percentage. The estimated allowed amount supplements and does not replace the payer-specific negotiated charges for all items and services.
Enforcement Capabilities
In addition to the changes above, CMS has modified requirements to improve enforcement capabilities and increase transparency. Enforcement changes include the following:
- CMS will require the submission of certification by an authorized hospital official as to the accuracy and completeness of the data in the MRF and the submission of additional documentation to determine hospital compliance.
- Require hospitals to submit an acknowledgment of receipt of the warning notice in the form and manner specified in the notice of violation issued by CMS to the hospital by the deadline specified.
- CMS will publicize on the CMS website information related to 1) CMS’ assessment of a hospital’s compliance, 2) Any compliance action taken against a hospital, and (3) Notifications sent to health system leadership.
Is your Hospital compliant with the 2024 Price Transparency requirements? If you need help, please contact ClaraPrice for a free price transparency evaluation. ClaraPrice provides fully-managed revenue cycle and compliance solutions for hospitals, including CMS-compliant JSON machine-readable service files for Price Transparency.